Psychiatric services : a journal of the American Psychiatric Association
-
The authors assessed base rates of firearm possession reported by hospitalized psychiatric patients. ⋯ A substantial proportion of hospitalized patients have access to firearms. Unless patients are directly asked about firearm access, this information may not come to the attention of health care providers. Strategies to manage the risk of suicide and violence by hospitalized patients may benefit from routine assessment of firearms possession.
-
This study examined the number of days that prisoners spent in a special disciplinary housing unit in New York State prison before a suicide occurred. ⋯ Because most suicides in a special housing unit occurred within eight weeks of placement, enhanced observation of special housing inmates is warranted in that period at a minimum.
-
Suicidal ideation frequently prompts visits to psychiatric emergency departments, and more information is needed about factors that mediate clinicians' decisions to hospitalize or discharge patients with suicidal ideation. ⋯ Psychosis, past suicide attempts, and the presence of a suicide plan robustly predicted the decision to hospitalize suicidal persons seen in psychiatric emergency services. Diagnosis, pharmacotherapy, having a psychiatrist, and insurance subtype were unrelated to hospitalization decisions, suggesting that psychiatric emergency department staff perceive few alternatives to hospitalization when psychosis and suicide plans accompany suicidal ideation.
-
Although antipsychotic polypharmacy is being prescribed with increasing frequency, few studies have described patient characteristics and treatment patterns associated with long-term use of this treatment strategy. ⋯ Long-term antipsychotic polypharmacy appears to be reserved for more severely ill patients with psychotic symptoms rather than mood symptoms. These patients may experience increased adverse effects as a result of excess antipsychotic exposure.
-
A significant proportion of patients of assertive community treatment (ACT) teams will adamantly refuse medication. Whether the team should continue to encourage medication or put a hold on advocating for medication is a clinical and ethical dilemma. On the basis of their clinical experiences, the authors propose best-practices criteria that ACT teams can consider in deciding whether medications may be temporarily discontinued when a patient refuses them. The authors suggest that in some circumstances stopping medications in such a case may help in the development or repair of a therapeutic alliance over the long term.